Public health funding and chlamydia and gonorrhea rates among adolescents during the COVID-19 pandemic in Ontario, Canada: An interrupted time series study

OBJECTIVES: We estimated the association between local public health infectious and communicable diseases (ICD) funding and chlamydia and gonorrhea trends before and during the COVID-19 pandemic among adolescents aged 13-19 in Ontario, Canada. STUDY DESIGN: Quasi-experimental, interrupted time series. METHODS: We conducted a population-based analysis using repeated cross-sectional data of chlamydia and gonorrhea incidence among adolescents across Ontario's 34 regional public health units from January 2015 to October 2022. We used negative binomial-regression to estimate changes in chlamydia and gonorrhea incidence before and during the COVID-19 pandemic, and whether these changes differed by 2019 ICD per capita public health funding. RESULTS: During the study period, there were 51,230 adolescent cases of chlamydia and 5256 of gonorrhea with most cases in females and older adolescents (age 18-19). Pre-pandemic, chlamydia rates increased over time (Risk ratio (RR) = 1.01, 95 % confidence interval (CI): 1.01-1.01, per month). There was an immediate decrease in chlamydia rates post-pandemic onset (RR = 0.26, 95 % CI: 0.12-0.53) though higher rates were observed with increasing 2019 ICD per capita funding (RR = 1.11, 95 % CI: 1.05-1.17, per dollar of ICD per capita funding, post-pandemic onset). Similar trends were observed for gonorrhea, but estimates had lower precision. CONCLUSION: Higher pre-pandemic 2019 ICD per capita funding may have allowed greater sexual health screening services during the COVID-19 pandemic, potentially mitigating a larger drop in STI detection. Results suggest that higher public health funding may allow for greater resilience of sexual health services during public health emergencies.